Provider Demographics
NPI:1457970063
Name:STUDIO AVANI
Entity Type:Organization
Organization Name:STUDIO AVANI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE/PT & ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PERCOCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT LICAC
Authorized Official - Phone:978-432-1277
Mailing Address - Street 1:217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1503
Mailing Address - Country:US
Mailing Address - Phone:978-432-1277
Mailing Address - Fax:
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-1503
Practice Address - Country:US
Practice Address - Phone:978-432-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy